MEDICARE: RAQUEL B MENDEZ CCPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0400X	Rehabilitation Chiropractor	CI390	FL

General Provider Information

NPI Number	:	1629298161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAQUEL B MENDEZ CCPA

Provider Business Mailing Address
First Line	:	458 E 19TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-4128
Country	:	US
Telephone Number	:	305-525-7190
Fax Number	:

Provider Business Practice Location Address
First Line	:	6726 W FLAGLER ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-2924
Country	:	US
Telephone Number	:	305-261-9560
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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Directions to “ RAQUEL B MENDEZ CCPA” Practice Location

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